Spinal Scoliotic Deformities: Adolescent Idiopathic, Adult Degenerative, and Neuromuscular

Core Knowledge in Orthopaedics: Spine

Volumn , Issue , 2005, Pages 137-156

  Sucato, Daniel J ^a,b  

^a UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER   (United States)

^b TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 84903088968     PISSN: None     EISSN: None     Source Type: Book    
DOI: 10.1016/B978-0-323-02731-1.50015-1     Document Type: Chapter

References (29)

1. Adolescent Idiopathic Scoliosis.
2. Cook S, Asher M, Lai SM, et al. Reoperation after primary posterior instrumentation and fusion for idiopathic scoliosis. Spine 2000, 25:463-468.
3. Lenke LG, Betz RR, Harms J, et al. Adolescent idiopathic scoliosis: A new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 2001, 83-A:1169-1181.
4. Lonstein JE, Carlson JM The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 1984, 66:1061-1071.
5. Richards BS Lumbar curve response in type II idiopathic scoliosis after posterior instrumentation of the thoracic curve. Spine 1992, 17:S282-286.
6. Suk SI, Lee CK, Kim WJ, et al. Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 2000, 20:1399-1405.
7. Albert TJ, Purtill J, Mesa J, et al. Health outcome assessment before and after adult deformity surgery: A prospective study. Spine 1995, 20:2002-2005.
8. Bradford DS, Tay BK, Hu SS Adult scoliosis: Surgical indications, operative management, complications, and outcomes. Spine 1999, 24:2617-2629.
9. Bridwell KH Adult deformity: Scoliosis and sagittal plane deformities. Principles and Practice of Spine Surgery 2003, Mosby, Philadelphia. A.R. Vaccaro (Ed.).
10. Bridwell KH, Lewis SJ, Lenke LG, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 2003, 85:454-463.
11. Grubb SA, Lipscomb HG, Sug PB Results of surgical treatment of painful adult scoliosis. Spine 1994, 19:1619-1627.
12. Schwab F, Dubey A, Pagala M, et al. Adult scoliosis: A health assessment analysis by SF-36. Spine 2003, 28:602-606.
13. Comstock CP, Leach J, Wenger DR Scoliosis in total-body-involvement cerebral palsy: Analysis of surgical treatment and patient and caregiver satisfaction. Spine 1995, 23:1412-1424.
14. Lintner SA, Lindseth RE Kyphotic deformity in patients who have a myelomeningocele: Operative treatment and long-term follow-up. J Bone Joint Surg Am 1994, 76:1301-1307.
15. Sponseller PD, LaPorte DM, Hungerford MW, et al. Deep wound infections after neuromuscular scoliosis surgery: A multicenter study of risk factors and treatment outcome. Spine 2000, 25:1461-2466.
16. Sussman MD Advantage of early spinal stabilization and fusion in patients with Duchenne muscular dystrophy. J Pediatr Orthop 1984, 4:532-537.
17. The authors analyzed a consecutive series of 182 patients who were treated with posterior spinal fusion for idiopathic scoliosis and demonstrated that the frequency for reoperation was 19%. The most common reason was late onset surgical pain in which the patients thought that the hardware was problematic. Removal of the hardware improved their symptoms. Other reasons for reoperation were pseudarthrosis, infection, and miscellaneous causes.
18. The authors describe a new classification for AIS that is more comprehensive than the King classification using a two-dimensional analysis of curves. The classification defines three components of the spinal deformity: curve type (1 through 6), a lumbar modifier (A, B, or C) and a sagittal thoracic modifier (-, N, or +). The authors demonstrate greater intraobserver and interobserver reliability than the King classification.
19. The author reviewed 24 patients with King type II curves to determine whether preoperative assessment of lumbar curve flexibility could predict postoperative outcome when treated with segmental spinal instrumentation. Despite 73% lumbar curve correction on the preoperative supine bend films, the magnitude of the lumbar curve remained larger than the instrumented thoracic curve and was partially caused by the residual obliquity of the fourth lumbar vertebra.
20. This retrospective clinical study compared the results of correction of AIS using pedicle screw fixation and hook fixation. The major coronal curve correction was 55% with hooks and 72% with screws. Patients who had hypokyphosis had better improvement and improved rotational correction when segmental screws were used.
21. This prospective study analyzed 55 adult scoliosis patients following surgery using the SF-36 outcome instrument. It demonstrated significant improvement in self-reported health assessment and function without losing the beneficial effects over time. There were no differences in outcome related to age (older than 40 years versus younger 40 years), distal extent of fusion, or the occurrence of a complication. The authors suggest that a more disease-specific outcome measurement tool would be appropriate in future studies.
22. This excellent review article provides an up-to-date description of the treatment of adult scoliosis and a good explanation of some of the controversial issues.
23. The authors report on 27 consecutive patients treated at a single institution with lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. A radiographic and functional outcome assessment was performed. The average increase in lordosis was 34 degrees with an associated improvement in sagittal balance of 13.5 cm. There was significant improvement in the Oswestry and pain scores, and most patients were satisfied with the procedure overall. There was one pseudarthrosis at the level of the osteotomy.
24. This study analyzed the outcome of spinal fusion in 20 patients with painful adult scoliosis and 25 patients with painful degenerative scoliosis. The follow-up was between 2 and 7 years. Pain rating; activity level related to standing, sitting, and walking tolerance; ability to work; and period of disability was assessed. The authors report a pseudarthrosis rate of 17.5% (all patients fused to the sacrum with posterior-only surgery). Pain relief was correlated with a solid fusion and was seen in 80% of patients with idiopathic scoliosis and 70% with degenerative scoliosis. Improvement in sitting, walking, and standing was seen.
25. The authors analyzed 22 patients with adult scoliosis and 27 patients with degenerative scoliosis (using the SF-36 outcome instrument) who had not had surgical treatment and compared them with norms for the US population. The results demonstrate that the patients with scoliosis had lower scores in all eight categories when compared with the general population and lower scores in seven of eight categories when compared with the US population 55 to 64 years old. The authors conclude that adult scoliosis is a medical condition with a significant effect in the fastest growing population in the US.
26. This retrospective review demonstrated that at a minimum follow-up of 2 years there was a 30% rate of late progression of the scoliosis, pelvic obliquity (>75°), and decompensation (>4 cm). Of the patients, 21% had revision surgery; however, 85% of the parents and caregivers were satisfied with the results of surgery.
27. The authors reviewed 39 patients who had myelomeningocele and resection of the kyphotic deformity. The average age at the time of surgery was 6 years and follow-up was 11 years. The correction of the kyphosis was from 111 degrees to 40 degrees postoperatively and 62 degrees at final follow-up. Of the 39 patients, 37 had an average increase of 3.2 cm in height of the lumbar spine.
28. This multicenter study analyzed 210 surgically treated patients and identified 21 patients who had a deep wound infection. Patients were analyzed and compared with 50 uninfected patients matched for age, diagnosis, and year of surgery. The risk factors for deep wound infection following spine surgery in these neuromuscular patients were severe cognitive impairment and the use of allograft. Identification of gram-negative organisms was common, and infection often led to the development of a pseudarthrosis.
29. The author reports improved outcome when surgical stabilization and fusion of scoliosis is performed in patients with Duchenne muscular dystrophy. This improvement in outcome is seen as a lower complication rate, shorter hospital stay, improved curve correction and overall balance, and more rapid return to daily life. The author recommends surgical treatment when the curve progresses to between 30 and 40 degrees.